Pediheart: Pediatric Cardiology Today

Latest Episodes:

Pediheart Podcast #252: Does Digoxin Reduce Mortality Between Norwood and Cavopulmonary Anastomosis In The HLHS Patient? May 19, 2023

Show notes

In this week’s episode we delve into the evidence for digoxin reducing mortality in the interstage period following Norwood palliation for HLHS. We speak with Assistant Professor of Pediatrics at the University of Pennsylvania, Dr. Michael O’Byrne about a recent analysis of the PHIS database using the relatively novel “preference based instrumental variable” approach to analysis of an observational data set. How does this approach allow for possible proof of causation of effect of a variable? Why might digoxin reduce mortality in the HLHS patient following stage I palliation? Are there patients in which the impact of this agent might be greater than others? These are amongst the many questions reviewed this week with Dr. O'Byrne.
https://doi.org/10.1016/j.ahj.2023.05.005

Pediheart Podcast #251: All About High Sensitivity Troponin Levels In Children May 12, 2023

Show notes

In this week's episode we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland.
DOI: 10.1161/CIRCULATIONAHA.122.063281

Pediheart Podcast #250: Mental Health Disorders In The Chronically Ill And Factors Adversely Affecting Diagnosis and Treatment May 05, 2023

Show notes

This week we delve into a critically important topic which is the mental health of our patients with chronic disease. How common are mental health issues amongst patients with sickle cell disease, cystic fibrosis and congenital heart disease? What accounts for differences in diagnosis or treatment of things like anxiety, depression or ADHD in these different chronic disease state patients? What is structural racism and how does this impact these findings? What is the solution to the under-recognition of mental health disorders in these chronic medcial patients? We speak with ACHD fellow at Texas Children's Hospital and the first author of this week's work, Dr. Vincent J. Gonzalez.
DOI: 10.1016/j.jpeds.2023.113411
Thanks to all who have been listening to the podcast the past 5 years on today's landmark, 250th episode.

Pediheart Podcast #249: Impact Of BMI On Clinical Outcomes In The Adult Fontan Patient Apr 28, 2023

Show notes

This week we delve into the world of adult congenital heart disease when we review a recent work from the ACHD team at UCSF that assesses the impact of BMI on clinical outcomes in the single ventricle adult Fontan patient. What is the cause of elevation in BMI in some Fontan patients? Is obesity the only explanation? Is BMI a modifiable risk factor for our Fontan patients and should exercise be 'prescribed' for these patients? If so prescribed, what type of exercise is best for the Fontan patient? This week's work's senior author, Dr. Anushree Agarwal, Assistant Professor of Medicine at UCSF, shares her insights into this important topic.
DOI: 10.1161/JAHA.122.026732
Also mentioned in today's episode is episode #222 with Dr. Dan Halpern of NYU medical center (https://www.stitcher.com/show/pediheartpediatric-cardiology-today/episode/pediheart-podcast-222-impact-of-cardiac-rehab-on-exercise-tolerance-in-the-achd-patient-206781483)

Pediheart Podcast Replay of #150: Exercise Training Effects On Repolarization Abnormalities Mimicking LQTS Apr 21, 2023

Show notes

This week in a replay of a previous co-branded episode with the SADS Foundation (SADS.ORG) from 2.5 years ago, we speak with Professor Peter Schwartz of University of Pavia about a recent work he authored on the topic of changes in repolarization amongst well trained athletes. Can athletic training masquerade as LQTS causing prolongation and/or abnormalities in the QT interval? How can these patients be properly identified and not 'lumped' into the LQTS 'pile'? This is a very important work by one of the foremost authorities on the planet on LQTS and Professor Schwartz also shares with us how he became interested in this topic 50+ years ago as well as some pearls for clinical investigators at the start of their careers. One of the best and most inspirational interviews of the entire nearly 250 episode series!
doi: 10.1161/CIRCULATIONAHA.120.048916

Pediheart Podcast #248: Challenges Of Training The Next Generation Of Congenital Heart Surgeons Apr 14, 2023

Show notes

In this episode we speak with Professor of Surgery at the University of Pennsylvania, Dr. Stephanie Fuller about a recent work she co-authored on the impressions of CT surgical trainees and attitudes towards the field of congenital heart surgery. What factors were important amongst those surgeons who chose to pursue the field? What are the obstacles that may make it less appealing to the CT surgical trainee? How can surgeons be effectively trained in this demanding field in an era of public reporting and USNWR rankings? What sort of innovation is happening today to improve the training of congenital heart surgeons? Dr. Fuller shares her deep insights this week.
doi: 10.1053/j.semtcvs.2022.03.004

Pediheart Podcast #247: A Conversation With Living Legend Dr. Welton Gersony Apr 07, 2023

Show notes

This week we sit down and speak with living legend of pediatric and congenital cardiology, Dr. Welton Gersony who is Professor Emeritus of Pediatrics at Columbia University. Dr. Gersony was the chief of cardiology for 4 decades at NY Presbyterian Hospital and is the winner of innumerable awards in our field. Today we speak with him about his life, choices and what he loved most about medicine and cardiology. What does he view as maybe his biggest impact? What was it like to work directly with/for Dr. Alexander Nadas? What is Dr. Gersony's relationship to the Kennedy family? All this and more in this fascinating discussion with someone who was there for so much of the beginning of our field and who continues to contribute even to this day.

Pediheart Podcast #246: What Is The Best Anticoagulant For The Small Paracorporeal VAD Patient In 2023? Mar 31, 2023

Show notes

This week we review a recent report that focuses on the question of whether the direct thrombin inhibitor, bivalirudin is superior to heparin for the small patient with a paracorporeal device both from a medical and financial perspective. Bivalirudin is 40x the cost of heparin but does that capture all of the costs and how does overall cost differ between patients treated with one versus the other agent? We speak with Assistant Professor of Pediatrics at University of Vermont, Dr. Danielle Burstein about a large PHIS database study she recently published on this topic.

- DOI:

10.1016/j.healun.2022.10.006
Also joining us this week is Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. David Ezon to share with us the exciting news about our upcoming, in person, imaging course entitled: The Right Heart - Conversations In Care. The list of speakers is dizzying and come from the worlds of imaging but also interventions - both surgical and cardiac catheterization. Amongst a cast of many world authorities in the worlds of surgery, intervention and imaging, also joining the fun will be two true giants of cardiology and cardiac pathology, namely Dr. Ira Parness and Dr. Richard Van Praagh.
For those interested, take a look at the website to learn more at:
https://mssm.cloud-cme.com/course/courseoverview?P=5&EID=28135

Pediheart Podcast #245: Can Machine Learning Models Help Guide Timing For Postoperative Pacemaker Insertion? Mar 24, 2023

Show notes

This week we delve into the world machine learning and decision tree analysis modeling as it is applied to postoperative heart block decisions. Traditional thinking suggests that all congenital heart surgical patients with postoperative heart block should be observed for 7-10 days to allow for possible resolution of conduction block. However, is 7 days truly required in all cases? Are there patients in whom 7 days is not necessary? What could the impact be of earlier pacemaker insertion in these patients? How early can the decision to pace permanently be made and in whom? How does machine learning allow for a potentially more powerful model for this sort of analysis? We speak with Assistant Professor of Pediatrics at The Icahn School of Medicine at Mount Sinai, Dr. Son Duong about an exciting work he co-authored at Stanford University.
DOI: 10.1161/CIRCEP.122.011145

Pediheart Podcast #244: Why Is LQTS Sometimes Overdiagnosed? Mar 17, 2023

Show notes

This week's episode of the podcast is supported by the SADS Foundation (SADS.ORG) and is on the topic of the overdiagnosis of LQTS. What sorts of conditions can lengthen the QT interval without true congenital LQTS syndrome? What are the most common errors of ECG interpretation that account for misdiagnosis of this condition and are there leads of the ECG that might help or hurt when attempting to accurately measure the QT interval. What is the role of the ICD in the LQTS patient? We speak with Professor of Pediatrics, Medicine and Pharmacology at the Mayo Clinic Alix School of Medicine, Dr. Michael Ackerman about a recent work he published on this important topic.
doi: 10.1016/j.jacc.2022.11.036.

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